Hemiplegic migraine is a rare form of migraine that some people confuse with a stroke. With this type of migraine, a person may also develop neurological symptoms, including weakness on one side of the body.

Hemiplegic migraine comes in two categories: familial hemiplegic migraine (FHM) and sporadic hemiplegic migraine (SHM).

This article explores the symptoms, causes, and treatment options associated with both types of hemiplegic migraine.

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The two distinct types of hemiplegic migraine have slightly different causes, symptoms, and risk factors. The sections below look at these in more detail.

FHM

This form of hemiplegic migraine occurs in families in which there may be a genetic anomaly or mutation. This type affects the communication between parts of the brain called neurons and chemical neurotransmitters.

When a person has FHM due to a genetic factor, they have a 50% chance of passing this genetic trait to their children.

Typically, people begin to notice FHM symptoms during childhood and adolescence. Symptoms may decrease with age.

SHM

Often, those with SHM do not have family members with hemiplegic migraine.

That said, the condition can still arise from a genetic anomaly, and it can sometimes overlap with FHM. This is because a person with SHM may be the first person in a family to receive a diagnosis. However, this does not rule out the possibility that they have a parent with the genetic trait who has never experienced symptoms.

Although the symptoms can vary from person to person, they may include:

  • unilateral body weakness in the face, arms, or legs
  • visual disturbances, such as blind spots, light flashes, zigzags, or double vision
  • numbness or tingling of the face or in an extremity, such as an arm or a leg
  • speech difficulty
  • headache
  • motor weakness
  • clumsiness or lack of coordination
  • confusion
  • drowsiness
  • change in consciousness
  • memory loss
  • sensitivity to light or sound
  • psychosis

Some people have more severe symptoms. If this is the case, symptoms can include:

Short-term vs. long-term symptoms

People who have hemiplegic migraine may experience neurological symptoms that last from 1 hour to several days. Most people’s motor symptoms will resolve after 72 hours, but they may persist for weeks in some cases. These symptoms may include:

  • coordination difficulties
  • sensory changes
  • language changes
  • involuntary eye movements

Genetic anomalies can cause both types of hemiplegic migraine. For FHM, certain foods, stress, or a minor head injury may also be a trigger.

As many as 12–60% of those who have migraine report that certain foods are a trigger. Foods that often cause a problem include:

  • alcohol
  • cheese
  • chocolate

Alcohol may contribute to migraine due to the increased risk of dehydration and the sleep disturbance it may cause.

Alcohol triggers vary, but migraine often occurs after consuming:

  • red wine
  • beer
  • sparkling wine
  • whiskey

Due to high levels of the chemical tyramine, certain cheeses and other foods can also trigger migraine. Foods with high levels of tyramine include:

  • aged cheeses, such as gouda or parmesan
  • many meats
  • olives
  • pickles
  • chocolate
  • nuts

The caffeine content in chocolate may also contribute to headaches. Similarly, stress and hormonal changes inducing chocolate cravings may be factors.

The presence of irregular chemical and electrical brain signals are additional possibilities. These affect how the brain processes chemicals known as neurotransmitters.

In order to diagnose hemiplegic migraine, a doctor will examine the person and look at their symptoms. The doctor will also look at their family history.

To receive a diagnosis, the person will need to have had at least two hemiplegic migraine episodes.

Hemiplegic migraine has a two-part definition. Firstly, to receive a diagnosis of hemiplegic migraine, a person must be experiencing temporary symptoms relating to motor weakness, vision, senses, or speech.

In addition, they must have at least two of the following characteristics:

  • at least one neurological symptom that spreads gradually over 5 minutes or more
  • two or more symptoms that occur in succession
  • each individual non-motor symptom lasting for 5–60 minutes, and motor symptoms lasting for up to 72 hours
  • at least one symptom on one side only
  • the visual, sensory, or motor symptom accompanied or followed by a headache within 1 hour

For a correct hemiplegic migraine diagnosis, the doctor needs to rule out all other potential causes of the symptoms. Other potential causes include a transient ischemic attack, a stroke, and a seizure.

The goal of treating hemiplegic migraine is prevention and symptom management, but it depends on the severity of the symptoms.

Treatment may include the use of medications, such as:

Due to the risk of stroke, doctors warn people with hemiplegic migraine against taking certain medications. These include drugs that constrict blood vessels, such as triptans and ergotamines.

There are two kinds of hemiplegic migraine: FHM and SHM.

Although FHM results from a genetic factor and tends to run in families, a variety of triggers can contribute to the development of symptoms. These include certain foods and stress.

Doctors may treat the condition with medications, depending on the severity of a person’s symptoms. Hemiplegic migraine is treatable.